First magnetic resonance imaging-guided cardiac radioablation of sustained ventricular tachycardia

Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance

“…Second, clinical CRs on SBRT to manage peculiar oncological cardiac localization (mostly sarcomas) ( 15 ). Finally, some CRs ( 8 , 9 , 16 ), two case series (CS) ( 2 , 7 ) and the result of a Phase I/II trial ( 6 ) investigated the application of SBRT in the cardiological frame (STAR). In particular, both the first report of Cuculich et al ( 2 ) and the recent Phase I/II trial (Encore VT) from the same Group ( 6 ) suggested the efficacy and safety of such procedure.…”

“…To this regard, two main issues are of high relevance: cardiac target definition by accurate mapping, and the specific details of STAR planning and delivery. The available clinical experiences adopted 3 type of devices for STAR: Cyberknife ( 16 , 19 ), Image guided radiation therapy (IGRT)-Linac ( 2 ), and the MR-guided radiotherapy (MRgRT) system ( 9 ). All of them provide accurate image guidance ensuring image guided patient positioning and monitoring of both inter- and intra-fractional patients positioning errors, aiming to minimize delivery errors.…”

“…Recent case series (CS) report about the efficacy and safety of stereotactic arrhythmia radioablation (STAR) ( 6 , 7 ), but these reports collect together <30 patients. To this regard, some case reports (CR) also provided insights in this regard addressing different perspectives of this new approach (i.e., STAR) for a well-established procedure (i.e., SBRT) ( 8 , 9 ). Still many issues about details of STAR have been not standardized, including: the ideal workflow, the radiation therapy best performing machine, definition of margins expansion for target delineation, the indications about the best image guidance limiting procedural error.…”

Stereotactic Radiotherapy for the Management of Refractory Ventricular Tachycardia: Promise and Future Directions

“…Recent advances in medical imaging and RT have improved target definition and tracking accuracy. New image-guided RT techniques are currently emerging, including MRI-linac that can combine the possibility of continuous non-ionizing imaging with direct target tracking ( 73 ). In the future there is probably a lot to expect from protons and carbon ions as many pre-clinical studies are based on these particle beams ( 74 ); a first VT patient has been recently treated using protons ( 75 ).…”

Future Perspectives and New “Frontiers” in Cardiac Rhythmology

“…In addition, to date, the ability for simultaneous gating of respiratory and cardiac movement is lacking. In this respect, the recent first in men stereotactic radioablation performed on a hybrid MR-Linac field permitting real-time tracking and beam-gating is, indeed, promising (37).…”